Total bilirubin 70. Total bilirubin is increased: what does this mean in an adult. Direct and indirect bilirubin

In daily practice, doctors often have to deal with conditions when, according to research results, increased bilirubin in the blood is recorded. How to correctly assess such a condition, why it arose and what needs to be done about it is described in general terms in this article.

Everyone should know this...

For understanding common man bilirubin is pigmented Chemical substance, which is constantly formed in the body and must circulate through only one metabolic pathway. Its direction consists of several consecutive links in the chain of the bilirubin cycle. These include:

1. Bilirubin formation. Occurs in the spleen, where red blood cells that have completed their life cycle are destroyed. When hemoglobin breaks down, total bilirubin is formed. Through the splenic vein it rushes into the systemic bloodstream. The portal vein brings it to the liver, where neutralization occurs;
2. Conjugation. This process is based on its combination with glucuronic acid, which occurs in the liver. This is necessary in order to neutralize bilirubin in the blood, because it is very toxic to tissues;
3. Excretion. Conjugated (bound) bilirubin in the liver is less toxic to the body and therefore as soon as possible must be removed from the body. This happens by its release from the liver with bile into the duodenum. The main part is excreted in the feces in the form of stercobilin. The part that is absorbed into small intestine, is excreted by the kidneys in urine in the form of urobilin.

Normal bilirubin levels in biochemical analysis

Assess condition bilirubin metabolism in the body allows a biochemical blood test. The main indicators include:

• Indirect bilirubin. This indicator reflects the part of bilirubin that has not been neutralized in the liver;
• Direct bilirubin is a fraction that has been inactivated in liver cells by binding to glucuronic acid;
• Total bilirubin is the combination of direct and indirect bilirubin. This indicator is the most important guideline when assessing bilirubin metabolism and determines the feasibility of determining individual bilirubin fractions. If it is normal, then this is not necessary. If the norm is exceeded, there is a need for a detailed study of the fractions of this substance, which will help determine the cause of the increase in bilirubin in the blood.

Generally accepted standards for bilirubin metabolism are shown in the table.

What is the danger if the indicators exceed the norm?

Bilirubin, as an extremely toxic compound, causes intoxication of the body and disruption of functioning important organs. The tissues of the brain are considered the most sensitive in this regard. All other systems (heart, liver, kidneys) are more resistant to its action and are able to function for a long time under conditions of increased bilirubin concentration. It all depends on the severity of this increase, which is called hyperbilirubinemia.

With regard to specific figures for the increase in blood bilirubin, the following degrees and patterns can be noted:

1. Slight excess of the standard indicator. This type of hyperbilirubinemia may include an increase in the level total bilirubin dommol/l. It does not pose an immediate threat to life, since it does not cause severe intoxication and toxic damage to internal organs. A person can live with such bilirubin for a long time, but it is necessary to determine the causes of this condition;
2. Marked increase in bilirubin in the blood. These figures include its concentration dommol/l. Such conditions are dangerous, but not critical. The prolonged existence of such hyperbilirubinemia causes severe intoxication, which must be eliminated in the near future;
3. Severe hyperbilirubinemia. It is said to occur when the bilirubin level rises to 300 µmol/l. With such figures for this indicator, there is an immediate threat to the patient’s life due to severe intoxication and disruption of the functioning of internal organs;
4. Extremely severe hyperbilirubinemia. Bilirubin numbers that exceed 300 µmol/l are not compatible with life. If the cause of such an increase is not eliminated within a few days, this will lead to the death of the patient.

Yellowness of the sclera and skin - main symptom increased bilirubin

Not only analysis helps to identify the problem

Any pathological changes in the body are reflected in the form of certain symptoms. This rule is also relevant for hyperbilirubinemia, which manifests itself:

• Yellowness of the skin and sclera of the eyes. It occurs when the bilirubin level is more than 50 µmol/l. Its nature and intensity depend on the cause of the pathology and the degree of increase in the content of the substance;
• Itchy skin;
• Bitterness in the mouth;
• Darkening of urine;
• White color of stool;
• General weakness;
• Memory impairment and intellectual abilities;
• Enlarged liver and heaviness in the right hypochondrium.

Why does this happen

Determining the likely cause of increased bilirubin is not always easy. But only by finding out why this happened can you decide how you can help the person. The main diseases that may be hidden behind hyperbilirubinemia are shown in the table.

• Infectious diseases (malaria);
• Hemolytic anemia;
• Splenomegaly and hypersplenism;
• Intoxication of external and internal origin;
• Hemolysis in newborns with Rh conflict;
• Incompatibility of transfused blood.

• Presence of stones inside bile ducts and choledocholithiasis;
• Atresia of the biliary system;
• Myrisia syndrome;
• Gallbladder and duct cancer;
• Cholangitis;
• Caroli's disease;
• Chronic pancreatitis (indurative);
• Pancreatic cancer with tumor localization in the head.

• Viral and toxic hepatitis;
• Liver damage caused by infectious diseases any localization and sepsis;
• Cirrhosis of the liver;
• Liver cancer and metastases of malignant tumors;
• Fatty hepatosis of alcoholic or other origin;
• Genetic damage to enzymes that metabolize bilirubin (Gilbert, Dabin-Jones, Rotor syndromes);
• Pylephlebitis;
• Budd-Chiari syndrome.

Increased bilirubin in newborns is a physiological transient condition

How can you help?

You need to understand that an increase in bilirubin in the blood is not a separate pathological condition which requires specific treatment. Such a phenomenon should be considered only as a symptom of a number of diseases. The most important thing is to correctly identify exactly the one that caused the changes in the analysis results. Only treatment of the causative disease normalizes bilirubin. Therefore, in the presence of hyperbilirubinemia, it is unacceptable to try to help in other ways.

Many sources of information indicate that it can help reduce bilirubin special diet, herbs and other methods. But this is nothing more than absurd. There is only one condition in which minor hyperbilirubinemia should be corrected in this way: genetic defects in bilirubin metabolism enzymes in the liver. In all other cases, the person should be examined as early as possible. After all, help may require not only drug treatment, but also a complex operation.

Correct assessment and early definition the reasons for the increase in bilirubin maximizes the diagnostic significance of this indicator. This should only be done by a qualified specialist!

The newborn has had elevated bilirubin for 7 days, he is in Krasnodar maternity hospital No. 5, it reaches 300, he cries at night, his mother is worried. Tell me how to help the baby, what are your recommendations.

Sorry for the late reply. Judging by the indicators, my recommendations, unfortunately, are no longer relevant.

I began to feel bad: in the evening I think stupidly, there is fog in my head, there is also fog in my eyes, there is no attentiveness, when talking to an interlocutor, I can’t concentrate, something has become wrong with my memory - I forget, in the evening some kind of sticky mucus appears in my mouth . Red droplets appeared on the body, and the legs were cold in the evening. I donated blood for a fee for bilirubin and cholesterol, but I don’t have an appointment with my doctor. Total bilirubin is 27.6, and direct bilirubin is 11.8. Total cholesterol - 2.83.

Uv. Galina, urgently take all tests for tumor markers, your venous system no longer holds blood, passing fractions through the capillaries! Mucus is already a defect of the liver, if it doesn’t make you feel bitter and nauseous, you may not have time. Don’t delay with tumor markers, they can still save you or at least extend your life for several years.

I was in the hospital and was discharged today. I went to see the doctor to get a discharge from the hospital. Sitting in line, I looked at the statement and noticed that my bilirubin was elevated - total - 28.8. I noticed before that I periodically have pain in my right side, a little closer to the ribs. Sometimes nausea occurs. In 2008, my total bilirubin was 48.8, but I didn’t feel such discomfort, but now I feel like something is bothering me.

Unfortunately, this is not the liver. This is already a heart and then either a transplant or how long you can last on the machine. I advise you to look for a clinic, the sooner, the better your chances.

Hello! Passed a biochemical blood test. Total bilirubin - 22.6; straight - 10.2; total protein - 75; creatinine - 70; ALT -36; AST - 41. I am 81 years old. Is treatment required? Thank you!

What kind of doctor are you? Not a comment, but complete nonsense.

Were you looking for a commentator or a doctor?

Yes, I agree, the comments are stupid.

Hello! I have had yellow sclera and my body for a very long time since school, more than 10 years to be exact, I did a series of examinations - everything is clear, but bilirubin remains at 200 without changes. What forecasts can I expect, and is there any point in doing anything?

Hello, Natalia! How can you treat your health like that! Your bilirubin level is ten times higher, and you say, “Is it worth it..” This is your life, and its quality depends on you. Or you don’t care about yourself - forgive me for such a syllable. “Dig” the Internet and look for a way to somehow reduce the indicators. Cleanse your colon first. Drink immortelle, corn silk, rosehip decoction, review your diet, take care of your liver, finally. Caress her like a child, nurse her, and she will reciprocate your feelings. This is not nonsense, but the very truth. Until you love yourself, just as you love the world and your loved ones, nothing will change in improving your health. With respect, Nadezhda.

Health to everyone, people! a week ago I passed the UBC and biochemistry tests. Liver tests are almost all elevated, especially total and direct bilirubin - two times the norm. in 1988, after an accident with an anti-tetanus injection, hepatitis B was introduced into the blood, she was ill for a long time and everything was very difficult. Then diets, etc. I haven’t taken any tests at all for a long time. But on the eve of this diagnosis, I was fasting for the second day. I read somewhere that an increase in bilirubin may be associated with this. Answer please. I don’t eat fatty, fried, salted or smoked foods; meat is only poultry without skin, including turkey (not geese or ducks). I feel good, there is no heaviness. Sometimes there are unpleasant sensations in the liver area, I attribute them to stagnation of bile in gallbladder, no more.

I forgot to thank you for a very detailed and competent article.

Hello! Tell me which doctor we should contact. My son is 17 years old; his blood test for total bilirubin is -113. Ultrasound of all organs abdominal cavity fine. The liver corresponds to age without any pathologies. Hemoglobin 150. What could it be?

I am 62 years old. I took a blood test. It showed total bilirubin 28*8, indirect 15.7, direct 13*1. What is this. It’s very bad and what should I do?

I took the test - total bilirubin 16, direct 6.0, indirect 10.0, alat 97, asat 86, what should I do?

I can’t sleep. I was discharged from the neurological department. They took me away with grade 2 DEP. After 5 days I was as healthy as a horse. And now it’s the same. In the extract I read that bilirubin was 42.7. I'm shocked. It doesn't hurt, doesn't hurt, doesn't bother me. I DO NOT DRINK at all and I don’t smoke. So what, my liver isn’t working?

My total bilirubin is 36, cholesterol is 5.19, Blunt pain in the right hypochondrium, in the morning nausea, dry mouth.

A boy was born, increased bilirubin, tell me what is needed or what should be done?

What if bilirubin is slightly elevated? What to do?

You most likely have hemorrhoids, urgently run to the pharmacy for candles, you may still have time. Slightly elevated bilirubin is serious.

My friend is a hockey player. Today we discovered a high level. bilirubin. This has something to do with sports (he was told that if he continues to play, he might not live even four years.)

Hello, please tell me, I donated blood and according to the results, total bilirubin is 20.7. Other liver tests are normal. Blood parameters are normal, is any additional examination required? I have problems with the flow of bile from my gallbladder.

Total bilirubin was increased (24.5), other indicators were normal.

Hello! My son is 15 years old. The yellowed sclera alerted me. According to the tests, total bilirubin is 66 µmol/l, and according to ultrasound, the right side of the liver is enlarged by 2 times. What could it be? We live on the periphery in the Krasnoyarsk Territory. What are your recommendations to our further actions in establishing a diagnosis. Where is the best place to go? Best regards, Ekaterina

The doctor here apparently visits the site very often, and as I see it, he gives advisory opinions during the time.

My personal advice! - Google less about diseases, better go to specialists immediately! And don't waste your condition! Our life is in our hands!

Blood test for bilirubin. Why is high bilirubin level dangerous?

Blood test for bilirubin

Bilirubin is a substance that is formed in the human body during the disposal of destroyed or damaged red blood cells. It is initially formed from parts of hemoglobin in the cells of the spleen, after which it penetrates the liver and is converted into a water-soluble form. Bilirubin is excreted mainly in bile and in small amounts in urine. A blood test shows the total concentration of this substance, as well as its fractions. This study is very important, since with a critical increase in the level of this toxic component, severe damage to the central nervous system.

Types of bilirubin

Bilirubin in the body is presented in the form of several fractions:

1. Indirect fraction, which is bile pigment. It is insoluble in water and can penetrate through cell membrane. The main toxic effect is associated with this. This fraction of bilirubin is synthesized in the cells of the reticuloendothelial system through the enzymatic transformation of heme, which is formed during the breakdown of hemoglobin. Next, it binds to carrier proteins, most often albumin, and penetrates the liver.
2. The direct fraction (free) is formed in liver cells by combining with glucuronic acid. Thanks to this reaction, the pigment acquires water-soluble properties and, together with bile, enters the duodenum. IN gastrointestinal tract bilirubin undergoes further changes. A small part of it is reabsorbed into the blood, and then filtered in the kidneys and excreted in the urine. Basically, it ultimately turns into stercobilin, which is found in feces and provides its characteristic color.

Some patients do not quite understand what total bilirubin is in a blood test. This value is obtained by adding the concentration of the direct and indirect fractions.

Bilirubin norms

A standard biochemical blood test is performed on an empty stomach, a fluid sample is taken from a vein (usually in the crook of the elbow). To get reliable results, before donating blood you should, at least for knocking, refuse to take fatty foods and alcohol. The analysis result may also be influenced by:

• some drugs acting on the blood coagulation system (heparin, warfarin, aspirin);
• pregnancy;
• overeating or compliance strict diet, in particular, fasting;
• caffeinated drinks;
• choleretic herbs.

As a rule, a blood test for bilirubin is performed in the following situations:

• during medical examination;
• when symptoms of jaundice appear, including in newborns;
• for diagnosing liver function in hepatitis, cirrhosis, tumors;
• in the presence of cholelithiasis or pancreatitis;
• with hemolytic disease;
• for various types toxic effects and poisoning;
• as a control of the effectiveness of therapy.

Three indicators are determined in blood plasma:

1. Total bilirubin, which is the total concentration of water-soluble and fat-soluble fractions. Its norm in an adult is 5.1-17 µmol/l.
2. The indirect fraction can range from 3.4-12 µmol/l. Its share is usually 70-75%.
3. The normal direct fraction is 1.7-5.1 µmol/l.

During pregnancy, a slight increase in the concentration of this substance can be considered normal. This is due to impaired blood flow through the portal vein as a result of increased intra-abdominal pressure and the effects of an enlarged uterus.

Bilirubin levels in newborns

The concentration of bilirubin in the plasma of newborns varies. This is due to the fact that after the start of breathing through the lungs, the composition of the child’s blood changes. In particular, fetal hemoglobin is replaced with normal hemoglobin. Therefore, massive destruction of this substance occurs and the formation of a large amount of heme, and, consequently, bilirubin. The following are considered normal indicators:

• in children in the first hours after birth – less than 60 µmol/l;
• on the third or fourth day - no more than 250 µmol/l (in premature babies this figure is 170 µmol/l);
• after a week – less than 170 µmol/l.

Subsequently, the concentration of this substance in the child’s blood gradually decreases to the level of an adult.

Under what conditions does bilirubin decrease?

Low bilirubin is detected quite rarely. This is most often observed in the presence of ischemic heart damage. However, this sign is not specific and is not used in diagnosing the disease. The same situation may occur while taking certain medications (phenobarbital, ascorbic acid, theophylline).

Another reason for such a change may be an erroneous determination of concentration. That is why in such cases it is advisable to perform a repeat study.

Why does the concentration of bilirubin increase?

The level of bilirubin in the blood can increase for three reasons:

• massive destruction of red blood cells (hemolysis);
• formation of an obstruction in the biliary tract;
• disruption of the formation of the water-soluble fraction in liver cells.

Active destruction of red blood cells can be observed when exposed to toxic agents, improper blood transfusion, and also as a result of hemolytic diseases. Since toxic substances are actively removed from the body, urine usually becomes dark in color.

Impaired hepatic metabolism of bilirubin is caused by damage to hepatocytes. This occurs with the following diseases:

• with hepatitis of viral or toxic etiology;
• with cirrhosis of the liver;
• as a result of certain types of congenital hereditary deficiency of a number of liver enzymes, for example, with Gilbert's syndrome;
• at tumor processes in this area;
• with a lack of vitamin B12.

An increase in direct bilirubin in the blood plasma is characteristic of gallbladder diseases. These include:

When the outflow of bile through the ducts is impaired, bilirubin in the feces decreases. The feces become a characteristic whitish color.

Why is high bilirubin dangerous?

An increase in the concentration of this pigment in the blood can lead to the development of toxic effects. Their appearance is associated with several mechanisms:

1. Penetrating into cells, it affects the respiratory cycle and leads to their death.
2. If the level of this hemoglobin breakdown product reaches a critical level, it can penetrate the blood-brain barrier into the nervous system. By affecting neurons, it leads to the development of toxic encephalopathy, and in severe cases- and to a coma.

Hyperbilirubinemia is usually accompanied by the following symptoms:

• staining of the skin and mucous membranes yellow in various shades;
• intolerable itchy skin;
• neurological disorders in the form of weakness, headache, irritability;
• dyspeptic symptoms;
• change in color of stool and urine.

In order to bring bilirubin levels back to normal, you should focus on treating the underlying disease.

In addition, the elimination of this toxic metabolite can be accelerated using forced diuresis or plasmapheresis.

Only by understanding what bilirubin is and which fractions of it change in specific diseases can this analysis be used to diagnose pathological conditions.

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Chubeiko Vera Olegovna - general practitioner, cardiologist, candidate of medical sciences. Ask a Question

Blood pressure 140 over 100, pulse 90 or 100. What is this?

Intestines hurt. Not much. Around the navel. Aching pain for 3 days. When I fall asleep, it hurts.

Why is bilirubin in the blood increased, and what does it mean?

Bilirubin is a yellow-green pigment that is formed when hemoglobin breaks down. In the human body it is found in the blood and bile. The liver is directly responsible for the exchange and excess of bilirubin.

Typically, high bilirubin manifests itself in the form of diseases such as jaundice, hepatitis or blood anemia.

Based on this, we can say that there are many reasons for increased bilirubin in the blood in adults, so you need to initially determine why this happened and what was the impetus for the increase in bilirubin.

What is bilirubin and where does it come from?

Why is an adult diagnosed with elevated bilirubin, and what does this mean? Hemoglobin is found in erythrocytes - human red blood cells; it carries oxygen to the body tissues from the lungs. Damaged and old red blood cells are destroyed in the spleen, liver and bone marrow. This releases hemoglobin and turns it into bilirubin.

Newly formed bilirubin is indirect and toxic to human body, especially for the central nervous system. Therefore, in the liver it is neutralized by other substances. Bound - direct bilirubin is secreted along with bile by the liver and leaves the body naturally. Dark color stool often indicates changes in bilirubin levels.

Classification

The metabolism of bilirubin is a complex chemical process that constantly occurs in our body; if it is disrupted at any stage, a change in the level of this substance in the blood serum appears. Therefore, bilirubin is important indicator work of several body systems at once.

Depending on the type, there are straight and indirect bilirubin.

• Indirect - the one that is formed as a result of the breakdown of hemoglobin. It is only soluble in fats and is therefore considered highly toxic. It is able to easily penetrate cells, thereby disrupting their functions.
• Direct - the one that is formed in the liver. It is water soluble and therefore considered less toxic. Direct bilirubin is excreted from the body along with bile.

Direct bilirubin is safe for the body, since it has been previously neutralized by liver enzymes. This substance leaves the body easily and does not cause much harm. Bilirubin indirect type is highly toxic, it was newly formed from hemoglobin and is not bound by liver enzymes.

Normal bilirubin level in blood

For an adult under 60 years of age, the normal result of a bilirubin test will be:

• 5.1-17 mmol/l – total bilirubin;
• 3.4-12 mmol/l – indirect;
• 1.7-5.1 mmol/l – straight.

Tables of normal levels of bilirubin in the blood for both sexes are almost the same. However, scientists have proven that Gilbert's syndrome is 10 times more common in men than in women.

Increased bilirubin in a newborn

Total bilirubin is increased - what does this mean in an adult?

For what reasons does the amount of total bilirubin in the blood increase in adults, and what does this mean? What factors contribute to this?

Depending on which process is disrupted, an increase in one of the bilirubin fractions may be observed in the blood. If an increase in total bilirubin with a uniform distribution of fractions is detected, then this is most characteristic of liver diseases.

Causes of elevated direct bilirubin

The level of direct bilirubin in the blood increases due to a violation of the outflow of bile. As a result, bile is directed into the blood rather than into the stomach. The reasons for this most often are the following pathologies:

• hepatitis of viral etiology in acute form(hepatitis A, B, infectious mononucleosis);
• hepatitis bacterial etiology(leptospirosis, brucellosis);
• chronic hepatitis;
• autoimmune hepatitis;
• drug-induced hepatitis(as a result of therapy hormonal drugs, nonsteroidal anti-inflammatory drugs, antitumor and antituberculosis drugs);
• toxic hepatitis (poisoning with mushroom poisons, industrial toxic substances);
• cancer of the gallbladder, liver or pancreas;
• cholelithiasis;
• biliary cirrhosis;
• Rotor and Dubin-Johnson syndromes.

Predominant increase in direct bilirubin levels. The basis is a violation of the outflow of bile.

Causes of increased indirect bilirubin

Diseases in which indirect bilirubin increases:

1. Gilbert, Crigler-Najjar, Lucy-Driscoll syndromes.
2. Infectious diseases - typhoid fever, sepsis, malaria.
3. Congenital hemolytic anemia- spherocytic, non-spherocytic, sickle cell, thallasemia, Marchiafava-Michele disease.
4. Toxic hemolytic anemia - poisoning with poisons, insect bites, snake bites, mushroom poisoning, lead, arsenic, copper salts (copper sulfate). Drug-induced hemolytic anemia - provoked by taking cephalosporins, insulin, aspirin, NSAIDs, chloramphenicol, penicillin, levofloxacin, etc.
5. Acquired autoimmune hemolytic anemias - develop against the background of systemic lupus erythematosus (symptoms, treatment), rheumatoid arthritis, lymphocytic leukemia, lymphagranulomatosis (symptoms, treatment), etc.

Predominant increase in indirect bilirubin levels. It is based on excessive destruction of red blood cells.

Liver problems

The liver has the most important in the processes of bilirubin production. With pathologies of this organ, the normal process of neutralizing free bilirubin and its transition to a direct state becomes impossible. Among the liver diseases in which bilirurin metabolism is disrupted are cirrhosis, hepatitis A, B, C, B and E, alcoholic and drug-induced hepatitis, and liver cancer.

The level of both types of bilirubin increases, which is manifested by the following symptoms:

• discomfort and heaviness in the right side due to liver enlargement;
• faded color of feces and dark color of urine;
• lightheadedness, belching after eating, especially severe discomfort from fatty and heavy foods;
• loss of strength, dizziness, apathy;
• increase in body temperature (with viral hepatitis).

May identify other causes of increased bilirubin levels. These include a hereditary deficiency of liver enzymes, this pathology is called Gilbert's syndrome. In patients, the level of bilirubin in the blood is significantly increased, so the skin and eye sclera often have a yellow tint.

Impaired outflow of bile

In diseases of the biliary system, for example, cholelithiasis, the patient usually has following symptoms:

• jaundice skin and sclera;
• pain in the right hypochondrium (very intense with hepatic colic);
• bloating, bowel dysfunction (diarrhea or constipation);
• discoloration of stool and dark urine;
• skin itching.

Unlike diseases of the blood and liver, in this situation the amount of direct (bound) bilirubin, which has already been neutralized by the liver, increases.

Prehepatic causes

The development of suprahepatic jaundice is caused by increased destruction of red blood cells. In this case, mainly the free fraction increases. Among the diseases are:

• hemolytic and B12-deficiency anemia;
• extensive hematomas;
• effects of toxic substances on blood cells;
• reaction to foreign blood transfusion or organ transplantation;
• thalassemia.

Symptoms

If the metabolism of bilirubin is disturbed, its quantitative indicators in the bloodstream can become large. This is expressed by jaundice, or yellow discoloration of the mucous membranes and skin.

1. If the concentration of bile pigment in the blood serum reaches 85 µmol/l, then they speak of a mild form of increase.
2. Jaundice with values ​​of µmol/l is considered moderately severe, and jaundice with values ​​above 170 µmol/l is considered severe.

Depending on the type of jaundice, its manifestations vary. The skin may take on a bright yellow, green or saffron yellow hue. In addition, with increased bilirubin, urine darkens (it becomes the color of dark beer), severe itching skin.

Other signs may include:

• bitterness in the mouth;
• darkening of urine;
• White color feces;
• general weakness;
• impaired memory and intellectual abilities;
• liver enlargement and heaviness in the right hypochondrium.

Gilbert's syndrome

How to treat increased bilirubin in the blood

Bilirubin can be reduced only after the cause of its increase has been established. This means that you will have to get tested for viral hepatitis, liver tests (determination of ast alt activity, alkaline phosphatase etc.), undergo an ultrasound of the liver and more specific studies.

At the same time, treatment in adults is mainly etiotropic, that is, it affects leading disease. For example, if the patency of the biliary tract is obstructed, it is necessary to remove stones or tumors; in some cases, duct stenting is effective.

If bilirubin is very elevated due to severe hemolysis of red blood cells, it is indicated infusion therapy with the introduction of glucose, albumin, as well as plasmapheresis. For neonatal jaundice, phototherapy is very effective, in which ultraviolet irradiation of the skin helps convert free toxic bilirubin into bound bilirubin, which is easily excreted from the body.

Why is bilirubin increased in urine, what does this mean?

4 comments

I was transferred from the maternity hospital to the Children's Clinical Hospital. There they measured Belerubin -267. We spent a month in the hospital. It went down, then up. They lay under a blue light lamp, gave ursofalk, did not let me go home, checked belerubin once a week.

Lots of tests. I suffered terribly. I don’t know how the milk didn’t disappear due to stress. While the child is under the lamp, I make sure that he doesn’t open his eyes or take off the blindfold, because looking at bright light lamps are not allowed. Then I pumped, because... The baby lost 10% of her birth weight. And I supplemented with bottle feeding. She at least sucked the bottle better; during the first month she got tired of suckling and fell asleep on the breast immediately. But she hasn’t weaned off the breast, the right person still doesn’t breastfeed correctly, and swallows air. Be healthy and patient to the whole family!

pregnant women 26 weeks urgently gave birth with the help of medicine his 300 µmol/l bilirubin still does not decrease then 250 toto 311 plays analysis already 21 days wife has been in intensive care the child is also in children's intensive care in a vacuum 29 weeks weight 740 g height 32 cm how long should they lie and treatment?

I gave birth at 30 weeks. I also had high bilirubin. The boy was 1 kg 900 g. Height 47 cm. He lay under the dome for 1 month. The child had pneumonia due to early birth. They treated me with three antibiotics and burned off the hemoglabin. I was discharged 10 days after giving birth, I came and brought diapers and waited. I pumped milk at home. Then a month later, when he got stronger and was able to breathe on his own and maintain his body temperature, I was admitted to him. We gained weight for 2 weeks, I breastfed him and supplemented him with formula. Now the boy is 4 years old. Everything is normal, only there is a slight lag in the maturity of the cerebral cortex, this is manifested in the fact that later than his peers he began to dress himself and eat. In your case, it is necessary pay attention to your vision, hearing and nervous system; due to low weight, pathologies are possible. Be sure to save the milk. What you did not add in the womb you will add with milk. Good luck to you.

GILBERT'S SYNDROME It is prohibited to study in military educational institutions, but you can serve in the army WHAT IS THIS RIDICULOUS AND BULLSHIT IF YOU CAN'T STUDY, IT MEANS YOU'RE NOT ELIGIBLE FOR SERVICE THERE IS NO EXEMPTIONS IN SERVICE ANYWHERE I SERVED FOR 27 YEARS AND I'M CONVINCED OF THIS FOR THE DIAGNOSIS SOMEONE SIGNS THESELF A VERDICT N

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When heme-containing proteins break down in red blood cells, bilirubin is formed - a special natural pigment of a yellow-green hue. This is a physiological process associated with the destruction of red blood cells that have served their purpose. Bilirubin is found in blood and bile, and its level is an important indicator of biochemical analysis. Exchange process The enzyme in question occurs in the body constantly. The full functioning of the liver depends on the level of this pigment. An increase in bilirubin may indicate dysfunction of red blood cells or bile flow.

What is bilirubin

This is the name of the breakdown product of hemoglobin, cytochrome and myoglobin - heme-containing proteins. The formation of this bile pigment occurs in the liver. The entire process of its metabolism includes several stages:

1. With the bloodstream, the pigment is transferred to the liver using a carrier - the protein albumin, which binds this toxic compound.
2. Bilirubin is released on the surface of hepatocytes. Here it enters the liver cells, where it binds to glucuronic acid. The toxicity of the enzyme disappears, and it can already dissolve in water and be excreted with bile from the body.
3. Next, the pigment enters the intestines, is transformed into urobilinogen, and is then excreted naturally along with feces.
4. A small part of the enzyme is absorbed and enters the bloodstream. These residues are filtered by the liver and excreted in the urine.

If a failure occurs at any stage, the blood begins to accumulate this pigment. It exhibits its toxic properties, which is why they suffer internal organs. Taking into account the characteristics of the metabolic process, bilirubin is divided into:

1. Indirect (unbound, free). This is the breakdown product of heme substances. It is toxic and easily passes through the cell membrane. Responsible for the delivery of bilirubin to the liver, where it is neutralized.
2. Direct (connected). This is already non-toxic bilirubin, which is formed in the liver and is subsequently excreted in feces. This type The enzyme is involved in the formation of bile.

Without taking into account these fractions, the level of total bilirubin in a person is determined, since it increases with an increase in any of the components. In general, this pigment acts as the main cellular antioxidant - a substance that binds free radicals. Thus, bilirubin slows down the oxidation processes. Additionally, it helps restore destroyed red blood cells.

Norm of total bilirubin

The amount of bilirubin in the blood is measured in µmol/l. To determine deviations, doctors determined the limits normal values this enzyme. Indicators vary for each type of pigment (indirect, direct, general), age and gender of the person. Women have slightly lower levels compared to men due to fewer red blood cells in the blood. General indicators of normal bilirubin are reflected in the table:

The norm of direct and indirect bilirubin in the blood

The amount of direct fraction should be about 25% of the total bilirubin, and indirect fraction accounts for about 75%. Normal values ​​in individual laboratories sometimes differ. This is due to the fact that reagents with different characteristics are used or analytical methods are modified. Differences can range from tenths to 1 µmol/l. The generally accepted standards are reflected in the table:

Increased bilirubin in the blood

Determining the amount of bilirubin is necessary, because when normal levels are exceeded, this bile pigment causes intoxication of the body. This leads to dysfunction of important organs: brain, liver, heart, kidneys. The first is the most sensitive in relation to the action of bile pigment. A condition in which the level of bilirubin exceeds normal by 50 µmol/l or more is called hyperbilirubinemia.

Causes

Taking into account the increased level of bilirubin pigment, hemolytic, mechanical, parenchymal and mixed jaundice are distinguished. The first three types are most often diagnosed. In addition, there is pseudojaundice, in which the skin accumulates carotenes, which is associated with long-term consumption of oranges, carrots or pumpkin. The difference between true jaundice is that not only the skin, but also the mucous membranes become yellow. An increase in certain indicators of bilirubin pigment indicates a certain type of jaundice:

• general – parenchymal (liver);
• direct – mechanical (subhepatic);
• indirect – hemolytic (suprahepatic).

Increased total bilirubin

The norms of this bile pigment have very wide boundaries, because its level can fluctuate under the influence of various external and internal pathological and physiological factors. Hyperbilirubinemia often occurs in following cases:

• after intense physical activity;
• when overeating;
• prolonged fasting.

If total bilirubin is elevated, this indicates liver damage, which is why hepatic jaundice develops. The skin takes on a rich orange or bright yellow hue. Such hyperbilirubinemia occurs with the following diseases or conditions:

• hepatitis;
• hepatosis;
• primary biliary cirrhosis;
• leptospirosis;
• Rotor syndrome - familial jaundice;
• tumors in the liver;
• mononucleosis;
• pylephlebitis;
• systematic use of alcohol.

Straight

If the direct fraction indicators increase, then the reason is inflammatory process in the gallbladder or disruption of the process of outflow of bile, which instead of the intestines enters the blood. This condition is called subhepatic (obstructive, mechanical) jaundice. The color of the skin and mucous membranes becomes yellow with a green or gray tint. If direct bilirubin is elevated, a person may be diagnosed with the following diseases or conditions:

• choledocholithiasis – stones or stones in the gall bladder;
• helminthiases;
• cholangitis;
• spasms and developmental abnormalities biliary tract;
• Mirizzi, Dubin-Johnson syndrome;
• biliary atresia;
• chronic pancreatitis;
• gallbladder injuries;
• post-inflammatory or post-operative strictures;
• bile duct cancer;

Indirect

An increase in the indirect fraction is observed with accelerated breakdown of red blood cells in the spleen, liver or bone marrow - pathological hemolysis, which is typical for newborns. Another reason is myolysis (destruction of muscle tissue) due to injury or myositis. Like hemolysis, it is not associated with the liver and occurs above it, even in circulatory system Therefore, developing jaundice is called suprahepatic.

If indirect bilirubin is increased, the skin becomes bright yellow with a bluish tint. The causes of this type of hyperbilirubinemia are the following pathologies or conditions:

• hereditary anemia(lack of iron);
• poisoning with hemolytic poisons (lead, mercury, toadstool);
• transfusion of blood incompatible by group or Rh factor;
• Rhesus conflict pregnancy;
• taking hormonal contraceptives, NSAIDs, anti-tuberculosis, painkillers, antitumor drugs;
• autoimmune diseases– rheumatoid arthritis, systemic lupus erythematosus;
• sepsis, typhoid fever, malaria;
• Gilbert, Crigler-Najjar syndrome.

Why is it elevated in women?

The reasons for increased bilirubin in the blood do not depend on gender. In women, jaundice may occur due to the diseases or conditions listed above. Pregnancy can be added to the list of causes of hyperbilirubinemia in the fairer sex. When carrying a child, the norm of bile pigment is 5.0-21.2 µmol/l. These indicators are not very different from those that non-pregnant women should have - 3.5-17.2 µmol/l.

Minor deviations are acceptable if, before conception, expectant mother there were no health problems. Otherwise, hyperbilirubinemia may indicate possible diseases of cardio-vascular system. Before this, they might not have manifested themselves in any way, but pregnancy provoked them, because the heart began to pump more blood. A woman’s gallbladder and kidneys experience the same intense regime during pregnancy. The following pathologies can be the causes of hyperbilirubinemia during pregnancy:

• toxicosis on early;
• cholelithiasis;
• intrahepatic cholestasis of pregnancy;
• eclampsia and preeclampsia;
• acute fatty degeneration liver.

In men

Hyperbilirubinemia in men can develop for the same reasons as in women, excluding only risk factors associated with pregnancy. In representatives of the stronger sex, other provocateurs of jaundice are noted. They are associated with the following factors characteristic of men:

• they smoke more;
• more often than women drink alcohol;
• take less care of personal hygiene;
• get tattoos more often;
• violate the diet.

Gilbert's syndrome is observed in men 2-3 times more often than in women. With this pathology, hyperbilirubinemia reaches levels of 80-100 µmol/l, with the indirect fraction predominating. The remaining causes of jaundice in men are no different from those typical for women:

• drug poisoning;
• chronic liver diseases;
• lack of vitamins B12;
• cirrhosis of the liver;
• cholelithiasis;
• chronic alcoholism;
• viral hepatitis.

In newborns

The norms of bilirubin pigment in children do not coincide with those for adults. Immediately after birth, the amount of this enzyme is almost the same as in mature people, but on the 4th day of life its level increases sharply. This can be seen by the baby's skin turning yellow. There is no need to be afraid of this condition, since physiological jaundice forms in newborns.

Hyperbilirubinemia in newborns is due to the fact that a certain number of red blood cells are destroyed to make room for new, already “adult” hemoglobin, and to give the fetal hemoglobin the opportunity to be eliminated from the body. This is a kind of reaction of the child’s adaptation to new living conditions. After a week, the baby’s skin acquires a normal shade, as the level of bilirubin pigment decreases to 90 µmol/l.

Then the indicators completely return to the norms characteristic of an adult. In addition to physiological jaundice, hyperbilirubinemia in newborns can occur in the following cases:

• in weak newborns;
• in premature babies;
• in babies born with pathology;
• in case of Rh conflict between mother and child;
• if the previous child had hemolytic disease requiring phototherapy;
• with significant bruises or hematoma of the brain;
• against the background of a loss of more than 10% of weight from birth, which is associated with a lack of milk in the mother;
• in large children;
• with Crigler-Najjar syndrome;
• if the mother has diabetes mellitus;
• for urinary tract infections.

Symptoms

A clear sign hyperbilirubinemia is an icteric color of the skin, sclera and mucous membranes. This is due to the fact that bile pigment enters the blood and body tissues, which gives them their color. In addition, it acts on nerve endings, causing severe itching in a person. Against the background of these signs, the following symptoms may be observed:

• nausea;
• bitterness in the mouth and belching;
• decreased appetite;
• discomfort, heaviness in the right hypochondrium;
• darkening of urine to the color of tea;
• white color of stool;
• general weakness;
• dizziness;
• fatigue;
• irritability;
• flatulence;
• cardiopalmus;
• headache;
• memory impairment;
• increase in liver size.

Why is elevated bilirubin in the blood dangerous?

The consequences of hyperbilirubinemia affect the functioning of the liver, gallbladder, nervous and digestive systems. Due to disruption of the digestion process, a person develops hypovitaminosis. Due to inadequate liver function, toxins and waste are not removed from the body, which leads to intoxication. Stones form in the gallbladder, after which cholecystitis develops. Hyperbilirubinemia is dangerous due to the development of the following pathologies:

• encephalopathy, accompanied by memory disorders, confusion, physical weakness;
• loss of consciousness and, in severe cases, coma due to damage to brain tissue.

Hyperbilirubinemia is divided into several degrees of severity depending on how much bilirubin levels exceed normal levels:

1. Minor. Increasing bile pigment levels to 50-70 µmol/l. There is no threat to life, severe intoxication and damage to internal organs are not noted. A person can live for a long time in this condition, but the cause of hyperbilirubinemia must be clarified.
2. Expressed. Here the concentration increases to 150-170 µmol/l. The condition is dangerous, but not critical. Over a long period of time, hyperbilirubinemia causes severe intoxication.
3. Heavy. The bilirubin level rises to 300 µmol/l. There is a threat to the patient’s life due to severe intoxication and disruption of internal organs.
4. Extremely heavy. Indicators exceed the level of 300 µmol/l. They are incompatible with life. If the cause is not eliminated within a few days, it will result in death.

How to treat

Hyperbilirubinemia is not a separate pathology, so it is necessary to treat the disease that has become the root cause this state. This is the only way to normalize the level of bile pigment and get rid of jaundice. To do this, the patient must undergo a series of tests: blood (general and biochemical), liver tests, and for viral hepatitis. Additionally they can assign ultrasonography liver.

After determining the cause of hyperbilirubinemia, the doctor selects a treatment regimen depending on the identified disease. In addition to etiotropic therapy, the patient is prescribed a special diet. Drug treatment depends on the identified cause of jaundice:

• if the outflow of bile is impaired, then choleretic agents are used;
• at birth defects red blood cells are eliminated only external manifestations illness;
• in case of infectious nature of bilirubinemia, treatment with antibiotics, immunomodulatory, anti-inflammatory and hepatoprotective drugs is recommended;
• for hemolysis of erythrocytes, infusion therapy with the administration of albumin, glucose and plasmapheresis is indicated;
• physiological jaundice Newborns are treated with phototherapy, in which, through ultraviolet irradiation of the skin, free toxic bilirubin is bound and removed from the body.

Drugs

Drug treatment of hyperbilirubinemia is aimed at eliminating its cause. The first stage of therapy is carried out in a hospital so that the doctor can monitor the patient. In addition, with parenchymal jaundice, bleeding may develop, so the patient may also require qualified assistance. Depending on the cause of hyperbilirubinemia, it is prescribed the following groups drugs:

• Sorbents and antioxidants. Indicated for the treatment of jaundice due to intoxication of the body. These drugs help remove toxins from the body and improve metabolism. Activated carbon and Enterosgel are used in this category of drugs.
• Detoxification solutions. Infused intravenously when the body is intoxicated. Often used in combination with sorbents, glucose and antioxidants to remove excess bile pigment.
• Choleretic. Used for bile outflow disorders (subhepatic jaundice). The drugs Hovitol and Allochol have a choleretic effect.
• Antibiotics. Necessary for bacterial nature of jaundice, for example, in the case of sepsis. The doctor may prescribe an antibiotic from the group of penicillins, macrolides or cephalosporins.
• Hepatoprotectors. Possess positive impact on liver functioning. They are used for non-obstructive cholestasis, when stagnation of bile is not accompanied by the formation of gallstones. An example is the drug Ursofalk, which is used for diseases of the liver and gall bladder. In case of hepatitis, it is recommended to take Essentiale, Hofitol or Karsil.
• Enzymes. Necessary for relieving inflammation and diluting bile. Such drugs include Festal, Panzinorm, Mezim.

Diet

While taking medications for hyperbilirubinemia, a special diet is required. It is aimed at alleviating the condition of the liver, gall bladder and the body as a whole. You need to eat often - up to 6 times a day in small portions, which leave a slight feeling of hunger after eating. The diet should consist mainly of foods rich in pectin and fiber: rowan berries, currants, rose hips, beets, apricots.

Every day you should include one type of cereal in your menu. For hyperbilirubinemia, buckwheat, oatmeal and rice are useful. The following products also have a positive effect in case of jaundice:

• stewed and boiled vegetables;
• protein chicken egg;
• herbal teas;
• sweet fruits;
• low-fat dairy products;
• lean meat fillet;
• vegetable and dessert milk soups;
• lean veal, beef, rabbit;
• salt-free bread;
• low-fat river (crucian carp, pike perch, pike, carp) and sea (blue whiting, cod, navaga, pollock) fish;
• still water;
• marmalade, honey

The use of products containing preservatives and dyes is not allowed. Fatty, fried and stewed meat, canned food, smoked meats, sausages, lard, liver and brains are also not allowed in the diet for jaundice. The list of prohibited products includes the following:

• horseradish, vinegar, mustard, spices;
• garlic, turnips, radishes, radishes, green onions;
• cream, full-fat sour cream and cottage cheese;
• cocoa, coffee;
• sour fruits - plums, citrus fruits;
• legumes, millet, white cabbage(increase fermentation in the stomach).

Video

Blood is the study of pigment metabolism in the body. It can be assessed by indicators of total bilirubin and individual fractions. In daily practice, doctors often have to deal with conditions when, according to research results, increased bilirubin in the blood is recorded. How to correctly assess such a condition, why it arose and what needs to be done about it is described in general terms in this article.

Everyone should know this...

For the common man to understand, bilirubin is a pigmented chemical that is constantly produced in the body and must circulate through only one metabolic pathway. Its direction consists of several consecutive links in the chain of the bilirubin cycle. These include:

1. Bilirubin formation. Occurs in the spleen, where red blood cells that have completed their life cycle are destroyed. When hemoglobin breaks down, total bilirubin is formed. Through the splenic vein it rushes into the systemic bloodstream. brings it to the liver, where neutralization occurs;
2. Conjugation. This process is based on its combination with glucuronic acid, which occurs in the liver. This is necessary in order to neutralize bilirubin in the blood, because it is very toxic to tissues;
3. Excretion. Conjugated (bound) bilirubin in the liver is less toxic to the body and therefore should be eliminated from the body as soon as possible. This happens by its release from the liver with bile into the duodenum. The main part is excreted in the feces in the form of stercobilin. The part that is absorbed in the small intestine is excreted by the kidneys in urine in the form of urobilin.

Important to remember! Bilirubin is a breakdown product of blood elements that has toxic properties to the tissues of the human body. The liver acts as the main responsible organ for its neutralization and removal from the body!

Normal bilirubin levels in biochemical analysis

A biochemical blood test allows you to assess the state of bilirubin metabolism in the body. The main indicators include:

• Indirect bilirubin. This indicator reflects the part of bilirubin that has not been neutralized in the liver;
• Direct bilirubin is a fraction that has been inactivated in liver cells by binding to glucuronic acid;
• Total bilirubin is the combination of direct and indirect bilirubin. This indicator is the most important guideline when assessing bilirubin metabolism and determines the feasibility of determining individual bilirubin fractions. If it is normal, then this is not necessary. If the norm is exceeded, there is a need for a detailed study of the fractions of this substance, which will help determine the cause of the increase in bilirubin in the blood.

Generally accepted standards for bilirubin metabolism are shown in the table.

What is the danger if the indicators exceed the norm?

Bilirubin, as an extremely toxic compound, causes intoxication of the body and disruption of the functioning of important organs. The tissues of the brain are considered the most sensitive in this regard. All other systems (heart, liver, kidneys) are more resistant to its action and are able to function for a long time under conditions of increased bilirubin concentration. It all depends on the severity of this increase, which is called hyperbilirubinemia.

With regard to specific figures for the increase in blood bilirubin, the following degrees and patterns can be noted:

1. Slight excess of the standard indicator. This type of hyperbilirubinemia can include an increase in the level of total bilirubin to 50-70 µmol/l. It does not pose an immediate threat to life, since it does not cause severe intoxication and toxic damage to internal organs. A person can live with such bilirubin for a long time, but it is necessary to determine the causes of this condition;
2. Marked increase in bilirubin in the blood. These figures include its concentration up to 150-170 µmol/l. Such conditions are dangerous, but not critical. The prolonged existence of such hyperbilirubinemia causes severe intoxication, which must be eliminated in the near future;
3. Severe hyperbilirubinemia. It is said to occur when the bilirubin level rises to 300 µmol/l. With such figures for this indicator, there is an immediate threat to the patient’s life due to severe intoxication and disruption of the functioning of internal organs;
4. Extremely severe hyperbilirubinemia. Bilirubin numbers that exceed 300 µmol/l are not compatible with life. If the cause of such an increase is not eliminated within a few days, this will lead to the death of the patient.

Important to remember! The main indicator of bilirubin metabolism in the body is total bilirubin. The degree of its increase determines the danger to human life and health. Indicators of direct and indirect bilirubin allow us to roughly determine the cause of deviations from the norm!

Yellowness of the sclera and skin is the main symptom of increased bilirubin

Not only analysis helps to identify the problem

Any pathological changes in the body are reflected in the form of certain symptoms. This rule is also relevant for hyperbilirubinemia, which manifests itself:

• Yellowness of the skin and sclera of the eyes. It occurs when the bilirubin level is more than 50 µmol/l. Its nature and intensity depend on the cause of the pathology and the degree of increase in the content of the substance;
• Itchy skin;
• Bitterness in the mouth;
• Darkening of urine;
• White color of stool;
• General weakness;
• Impaired memory and intellectual abilities;
• Enlarged liver and heaviness in the right hypochondrium.

Why does this happen

Determining the likely cause of increased bilirubin is not always easy. But only by finding out why this happened can you decide how you can help the person. The main diseases that may be hidden behind hyperbilirubinemia are shown in the table.

Increased bilirubin in newborns is a physiological transient condition

How can you help?

You need to understand that increased bilirubin in the blood is not a separate pathological condition that requires specific treatment. Such a phenomenon should be considered only as a symptom of a number of diseases. The most important thing is to correctly identify exactly the one that caused the changes in the analysis results. Only treatment of the causative disease normalizes bilirubin. Therefore, in the presence of hyperbilirubinemia, it is unacceptable to try to help in other ways.

Many sources of information indicate that a special diet, herbs and other methods can help reduce bilirubin. But this is nothing more than absurd. There is only one condition in which minor hyperbilirubinemia should be corrected in this way: genetic defects in bilirubin metabolism enzymes in the liver. In all other cases, the person should be examined as early as possible. After all, help may require not only drug treatment, but also complex surgery.

Correct assessment and early determination of the cause of increased bilirubin maximizes the diagnostic significance of this indicator. This should only be done by a qualified specialist!

Bilirubin is a yellow-green pigment that is formed when hemoglobin breaks down. In the human body it is found in the blood and bile. The liver is directly responsible for the exchange and excess of bilirubin.

Typically, high bilirubin manifests itself in the form of diseases such as jaundice, hepatitis or blood anemia.

Based on this, we can say that there are many reasons for increased bilirubin in the blood in adults, so you need to initially determine why this happened and what was the impetus for the increase in bilirubin.

What is bilirubin and where does it come from?

Why is an adult diagnosed with elevated bilirubin, and what does this mean? Hemoglobin is found in erythrocytes - human red blood cells; it carries oxygen to the body tissues from the lungs. Damaged and old red blood cells are destroyed in the spleen, liver and bone marrow. This releases hemoglobin and turns it into bilirubin.

Newly formed bilirubin is indirect and toxic to the human body, especially to the central nervous system. Therefore, in the liver it is neutralized by other substances. Bound - direct bilirubin is secreted along with bile by the liver and leaves the body naturally. Dark stool color often indicates changes in bilirubin levels.

Classification

The metabolism of bilirubin is a complex chemical process that constantly occurs in our body; if it is disrupted at any stage, a change in the level of this substance in the blood serum appears. Therefore, bilirubin is an important indicator of the functioning of several body systems at once.

Depending on the type, direct and indirect bilirubin are distinguished.

• Indirect - the one that is formed as a result of the breakdown of hemoglobin. It is only soluble in fats and is therefore considered highly toxic. It is able to easily penetrate cells, thereby disrupting their functions.
• Direct - the one that is formed in the liver. It is water soluble and therefore considered less toxic. Direct bilirubin is excreted from the body along with bile.

Direct bilirubin is safe for the body, since it has been previously neutralized by liver enzymes. This substance leaves the body easily and does not cause much harm. Indirect bilirubin is very toxic; it was recently formed from hemoglobin and is not bound by liver enzymes.

Normal bilirubin level in blood

For an adult under 60 years of age, the normal result of a bilirubin test will be:

• 5.1-17 mmol/l – total bilirubin;
• 3.4-12 mmol/l – indirect;
• 1.7-5.1 mmol/l – straight.

Tables of normal levels of bilirubin in the blood for both sexes are almost the same. However, scientists have proven that Gilbert's syndrome is 10 times more common in men than in women.

Total bilirubin is increased - what does this mean in an adult?

For what reasons does the amount of total bilirubin in the blood increase in adults, and what does this mean? What factors contribute to this?

Depending on which process is disrupted, an increase in one of the bilirubin fractions may be observed in the blood. If an increase in total bilirubin with a uniform distribution of fractions is detected, then this is most characteristic of liver diseases.

Causes of elevated direct bilirubin

Level direct bilirubin in the blood increases due to a violation of the outflow of bile. As a result, bile is directed into the blood rather than into the stomach. The reasons for this most often are the following pathologies:

• hepatitis of viral etiology in acute form (hepatitis A, B, with);
• hepatitis of bacterial etiology (leptospirosis, brucellosis);
• autoimmune hepatitis;
• drug-induced hepatitis (as a result of therapy with hormonal drugs, antitumor and anti-tuberculosis drugs);
• toxic hepatitis (poisoning with mushroom poisons, industrial toxic substances);
• cancer of the gallbladder, liver or pancreas;
• cholelithiasis;
• biliary cirrhosis;
• Rotor and Dubin-Johnson syndromes.

Predominant increase in direct bilirubin levels. The basis is a violation of the outflow of bile.

Causes of increased indirect bilirubin

Diseases in which there is an increase indirect bilirubin:

1. Gilbert, Crigler-Najjar, Lucy-Driscoll syndromes.
2. Infectious diseases - typhoid fever, sepsis, malaria.
3. Congenital hemolytic anemias - spherocytic, non-spherocytic, sickle cell, thallasemia, Marchiafava-Michele disease.
4. Toxic hemolytic anemia - poisoning with poisons, insect bites, snake bites, mushroom poisoning, lead, arsenic, copper salts (copper sulfate). Drug-induced hemolytic anemia - provoked by taking cephalosporins, insulin, aspirin, NSAIDs, chloramphenicol, penicillin, levofloxacin, etc.
5. Acquired autoimmune hemolytic anemias develop against the background of systemic lupus erythematosus (symptoms, treatment), rheumatoid arthritis, lymphocytic leukemia, lymphagranulomatosis (symptoms, treatment), etc.

Predominant increase in indirect bilirubin levels. It is based on excessive destruction of red blood cells.

Liver problems

The liver is most important in the processes of producing bilirubin. With pathologies of this organ, the normal process of neutralizing free bilirubin and its transition to a direct state becomes impossible. Among the liver diseases in which the metabolism of bilirurin is disrupted, there are hepatitis A, B, C, B and E, alcoholic and drug-induced hepatitis, and liver cancer.

Levels of both types of bilirubin increase, which is manifested by the following symptoms:

• due to liver enlargement;
• lightheadedness, belching after eating, especially severe discomfort from fatty and heavy foods;
• loss of strength, dizziness, apathy;
• increase in body temperature (with viral hepatitis).

May identify other causes of increased bilirubin levels. These include a hereditary deficiency of liver enzymes, this pathology is called Gilbert's syndrome. In patients, the level of bilirubin in the blood is significantly increased, so the skin and eye sclera often have a yellow tint.

Impaired outflow of bile

With diseases of the biliary system, for example, cholelithiasis, the patient usually exhibits the following symptoms:

• yellowness of the skin and sclera;
• pain in the right hypochondrium (very intense with hepatic colic);
• , bowel dysfunction (diarrhea or constipation);
• discoloration of stool and dark urine;
• skin itching.

Unlike diseases of the blood and liver, in this situation the amount of direct (bound) bilirubin, which has already been neutralized by the liver, increases.

Prehepatic causes

The development of suprahepatic jaundice is caused by increased destruction of red blood cells. In this case, mainly the free fraction increases. Among the diseases are:

Perhaps, if not everyone, then most of us have heard about such an indicator as bilirubin. Many people know that an increase in its content in the blood serum accompanies various liver diseases and can be observed in newborn babies, and the main clinical manifestation of disorders of its metabolism is jaundice. What are the reasons for the increase in bilirubin, the mechanisms and consequences of these disorders? This will be discussed in our article.

What is bilirubin?

Bilirubin is classified as a so-called hemoglobinogenic pigment. The main amount (about 85%) is formed during the physiological breakdown of old, worn-out red blood cells. The rest, a smaller part, appears during the destruction of other heme-containing substances - cytochromes, myoglobin.

The breakdown of red blood cells occurs mainly in the liver, spleen, and also in the bone marrow. About 1% of red blood cells are destroyed in the body per day, and up to 300 mg of bilirubin is formed from the hemoglobin they contain. This pigment is found in the blood normally, but its amount should not exceed the maximum permissible values.

To date, the structural features, metabolism, as well as the causes of disturbances in bilirubin metabolism have been studied and described quite well. When jaundice appears, and this is the main symptom of hyperbilirubinemia, diagnosis in most cases does not present significant difficulties (see, diseases accompanied by jaundice).

The main stages of bilirubin metabolism

So, when red blood cells are destroyed, bilirubin is formed, which is a toxic and water-insoluble compound. Its further transformation occurs in several stages:

• Bilirubin is transported through the bloodstream to the liver - this requires a carrier, which is the protein albumin, which quickly and firmly binds toxic bilirubin in the blood plasma. Such a protein-bilirubin complex is not able to penetrate the kidney filter, and therefore does not enter the urine;
• penetration of bilirubin into the liver cell after its separation from albumin on the surface of the hepatocyte membrane and further transportation along the membranes of the endoplasmic reticulum;
• conjugation (binding) of bilirubin with glucuronic acid in the endoplasmic reticulum and the formation of bilirubin diglucuronide. It is in this bound state that bilirubin becomes soluble in water and can thus be excreted in bile and urine from the body;
• excretion (excretion) with bile is the final stage of the exchange of bilirubin, which in the intestine is converted into urobilinogen and is excreted in the feces as stercobilinogen. Not a large number of bilirubin is absorbed by the intestinal wall and, entering the bloodstream, is filtered by the kidneys and excreted in the urine.

Norm of bilirubin

Based on the characteristics of metabolism, direct and indirect bilirubin are isolated. To assess the degree and nature of disorders in the metabolism of bilirubin, it is necessary to know it normal indicators in healthy people:

• Indirect (unbound, unconjugated, free) bilirubin, which is a breakdown product of heme substances, is toxic bilirubin. The amount of indirect bilirubin should not exceed 16.2 µmol/l.
• Direct (conjugated, bound), formed in the liver upon binding to glucuronic acid. This is bilirubin, which has already been neutralized by the liver and is ready to be excreted from the body. Direct bilirubin, norm 0 – 5.1 µmol/l
• Total bilirubin ranges from 0.5 – 20.5 µmol/l

In unfavorable conditions, it is possible to increase the level of both direct and indirect bilirubin, called hyperbilirubinemia. The predominance of one or another fraction depends on the causative factor that led to an increase in its content in the blood serum.

Symptoms of increased bilirubin in the blood (hyperbilirubinemia) in the form, first of all, jaundice appear when it exceeds 34 µmol per liter.

It happens that the bilirubin content is tens of times higher than the permissible values, which puts the patient’s life at risk and requires immediate assistance.

Signs of elevated bilirubin

As is known, the primary role in the metabolism of bilirubin belongs to the liver, and jaundice - characteristic syndrome, reflecting its damage and also manifests itself in cases where the amount of bilirubin exceeds the functional ability of the liver to bind its excess, or there are obstacles to the outflow of bile and, accordingly, the removal of conjugated bilirubin from the body.

Sometimes it happens that the severity of jaundice does not correspond to the levels of bilirubin in the serum. For example, with obesity and edema, jaundice is less noticeable, while in thin and muscular people it is more pronounced.

Causes high bilirubin in the blood are very diverse and are associated either with its increased formation in the cells of the reticuloendothelial system, or with a disturbance in one or several metabolic links in the hepato-biliary system.

WITH clinical point In terms of vision, it is important to note that the degree of hyperbilirubinemia affects the staining pattern of various tissues:

• So, most often the sclera is the first to acquire a jaundiced tint.
• Oral mucosa
• Then the face, palms, soles and finally the entire skin turn yellow

It must be remembered that yellow discoloration of the skin is not always a consequence of hyperbilirubinemia. For example, when eating food containing large amounts of carotene (carrots, tomatoes), diabetes mellitus (decreased function thyroid gland) the skin may acquire a yellow tint, but in these cases the sclera will be of normal color (intact).

List of diseases accompanied by high levels of bilirubin in the blood

Diseases in which direct bilirubin is increased:

• Acute viral hepatitis (hepatitis A, B, hepatitis in infectious mononucleosis)
• Chronic hepatitis (hepatitis C), autoimmune hepatitis
• Bacterial hepatitis (brucellosis, leptospirosis)
• Toxic (poisoning with toxic compounds, fungi), medicinal (taking hormonal contraceptives, NSAIDs, anti-tuberculosis, anti-tumor drugs)
• Jaundice of pregnancy
• Liver tumors
• Biliary cirrhosis
• Hereditary jaundice - Rotor, Dabin-Johnson syndrome

Diseases in which indirect bilirubin increases:

• Congenital hemolytic anemias - spherocytic, non-spherocytic, sickle cell, thallasemia, Marchiafava-Michele disease
• Acquired autoimmune hemolytic anemias develop against the background of ), lymphocytic leukemia, etc.
• Infectious diseases - typhoid fever, sepsis, malaria
• Drug-induced hemolytic anemia - provoked by taking cephalosporins, insulin, aspirin, NSAIDs, chloramphenicol, penicillin, levofloxacin, etc.
• Toxic hemolytic anemia - poisoning with poisons, insect bites, snake bites, mushroom poisoning, lead, arsenic, copper salts (copper sulfate)
• , Crigler-Najjar, Lucy-Driscola.

Types of jaundice and the main causes of increased bilirubin in the blood

An increase in bilirubin in the blood is promoted by 3 main factors:

Destruction of red blood cells (accelerated or increased)

High indirect bilirubin in hemolytic jaundice is due to increased breakdown of red blood cells (hemolysis), which can be a consequence not only of hereditary defects of the red blood cells themselves (sickle cell anemia, spherocytosis), but also of a number of external reasons, For example:

• infections (malaria, sepsis, typhoid fever, mycoplasmosis);
• poisoning with hemolytic poisons of various origins (toadstool toxins, mercury, lead, snake venom, others);
• transfusion of blood incompatible by group or Rh factor;
• malignant tumors, in particular of hematopoietic tissue (leukemia, myeloma and others);
• massive hemorrhages (pulmonary infarction, extensive hematomas).

The following symptoms are characteristic of hemolytic jaundice:

• lemon-yellow discoloration of the skin and mucous membranes, sclera of the eyes
• pallor due to anemia due to increased destruction of red blood cells
• pain in the left hypochondrium due to an enlarged spleen
• possible increase in body temperature
• large amounts of sterco- and urobilin are found in feces and urine, giving them a dark color
• against the background of a lack of oxygen in the tissues of the body, a person may experience palpitations, headaches, and increased fatigue

Disruption of normal bile flow

Subhepatic jaundice develops when conjugated bilirubin enters the blood back into the blood due to a violation of its outflow with bile, most often occurring with cholelithiasis, acute and chronic pancreatitis, hepatic artery aneurysm, pancreatic or gallbladder cancer, diverticula duodenum. In this condition, direct bilirubin is high in the blood. The causes of this type of jaundice may be:

This type of hyperbilirubinemia (with gallstones, gall or pancreatic cancer) is characterized by:

• maximum icteric discoloration of the skin
• most patients complain of, which results in scratching of the skin
• since the binding function of the liver is not impaired in this case, it will be found in the blood increased amount conjugated bilirubin
• Unlike other types of jaundice, the stool will be acholic, that is, have an almost white color, which is due to the lack of stercobilin in it, and the urine will be dark in color
• there are periodic pains in the right hypochondrium or an attack of such pain with hepatic colic
• disruption of the gastrointestinal tract -), diarrhea, constipation, nausea, loss of appetite, bitter belching

Impaired metabolism and excretion of bilirubin

This disorder is accompanied by its excessive accumulation and, as a result, jaundice can be hereditary in nature - hereditary jaundice , or occur throughout life and complicate various diseases - acquired jaundice.

Hereditary jaundice

Disturbances that occur at the hepatic stage of bilirubin metabolism (binding, transport in the liver cell and removal from it) cause hereditary jaundice:

• Crigler-Najjar syndrome
• Gilbert's syndrome
• Dubin-Johnson syndrome

The most common is Gilbert's syndrome, a benign hyperbilirubinemia with a favorable prognosis.

The reasons for high bilirubin in the blood in this disease lie in the lack of a liver cell enzyme that ensures the binding of free bilirubin to glucuronic acid, so hyperbilirubinemia will be caused mainly by its unbound fraction.

The disease is hereditary and is accompanied by a defect in genes located on the second chromosome. The prevalence of Gilbert's syndrome varies worldwide. Thus, among Europeans it occurs in 3-5% of cases, while among Africans it occurs in 36%, which is associated with high frequency the occurrence of a characteristic genetic defect in them.

Often the disease is asymptomatic or with episodes of jaundice of varying intensity, which occur against the background of stress, excessive physical exertion, and when drinking alcohol. Considering the benign course and favorable prognosis, specific treatment such patients, as a rule, do not need it.

Acquired jaundice

Prehepatic jaundice occurs when the amount of newly formed bilirubin is so large that even the intensity of its binding by the liver increased by 3-4 times does not lead to the removal of excess from the blood serum.

Hepatic, or parenchymal, jaundice occurs as a manifestation various diseases, accompanied by damage to the liver parenchyma and bile capillaries, which entails a violation of the uptake, conjugation and excretion of bilirubin, as well as its return into the blood from the bile ducts during cholestasis (stagnation of bile) inside the liver. This is one of the most commonly developing types of jaundice, in which direct bilirubin is high.

Diseases accompanied by hepatic jaundice are numerous and varied, but most often this type of hyperbilirubinemia is observed in hepatitis and.

Hepatitis- represent large group inflammatory liver lesions, which may be viral in nature or caused by non-infectious agents (drug-induced hepatitis, autoimmune, alcoholic).

In the acute course of the disease, the causative factor is most often a viral infection (hepatitis A, B, C, D, G), and manifestations include:

• signs of general intoxication with increased body temperature
• general weakness
• muscle and joint pain
• In this case, pain in the right hypochondrium will indicate liver damage
• icteric discoloration of the skin and mucous membranes
• changes in the color of stool and urine, as well as characteristic changes in laboratory parameters

As the disease progresses with the involvement of a significant volume of hepatic parenchyma in the process, as well as with obstructed outflow of bile, skin itching, bleeding, signs of brain damage in the form of characteristic hepatic encephalopathy and, ultimately, the development of hepatic-renal failure, which is life-threatening, may occur. often the cause of death of such patients.

Chronic hepatitis occurs quite often as a result of acute viral, drug and alcoholic liver damage. Their clinical manifestations are reduced to parenchymal jaundice and changes in biochemical analysis blood; during exacerbation, fever, arthralgia, and skin rashes are possible.

Liver cirrhosis- represent severe changes with loss of the normal histoarchitecture of its parenchyma. In other words, a disruption of the normal microscopic structure occurs: as a result of the death of hepatocytes, the liver lobules disappear, the orientation of blood vessels and bile capillaries is disrupted, and massive foci of growth appear connective tissue in place of damaged and dead cells.

These processes make it impossible for the liver to perform the functions of binding and removing bilirubin from the body, as well as detoxification processes, the formation of various proteins and blood clotting factors. Most often, cirrhosis of the liver ends with its inflammatory lesions (hepatitis).

In addition to parenchymal jaundice, clinical manifestations characteristic of cirrhosis include enlargement of the liver and spleen, skin itching, the appearance of fluid in the abdominal cavity (ascites), varicose veins veins of the esophagus, rectum, anterior abdominal wall.

Over time, signs of liver failure increase, brain damage develops, blood clotting decreases, and this is accompanied not only by rashes on the skin, but also by hemorrhages in the internal organs and bleeding (stomach, nasal, uterine), which are often life-threatening in nature.

Increased bilirubin in newborns

Hyperbilirubinemia, that is, increased bilirubin in newborns, deserves special attention. It is known that in the first days of life, most babies have one or another degree of jaundice, which is physiological in nature.

This happens because the child’s body adapts to extrauterine existence, and the so-called fetal (fetal) hemoglobin is replaced by “adult” type hemoglobin, which is accompanied by partial destruction of red blood cells. As a rule, the peak of yellowing is observed on days 3-5 of life, and after a short time it is resolved without causing harm to the child’s body.

In cases where hemolysis occurs in premature infants or is caused by Rh conflict or other reasons, a significant increase in the unbound fraction of bilirubin may occur with its penetration through the blood-brain barrier.

The result will be the development of so-called kernicterus, in which the nuclei of the brain are damaged, which poses a threat to the baby’s life and requires immediate intensive care.

In all cases, it is necessary to accurately establish the causes of high bilirubin in a newborn in order to avoid serious complications with timely treatment:

• physiological breakdown of red blood cells
• liver damage
• congenital anomalies of the biliary tract
• Rhesus conflict, etc.

How to reduce bilirubin?

Methods to combat hyperbilirubinemia depend on the reasons that caused it, however, if jaundice appears, you should not self-medicate, but should urgently consult a doctor. Since jaundice is only a symptom and treatment should first of all be aimed at eliminating its causes.

If bilirubin levels are high due to severe hemolysis of red blood cells, infusion therapy with the administration of glucose, albumin, as well as plasmapheresis is indicated. For neonatal jaundice, phototherapy is very effective, in which irradiation of the skin helps convert free toxic bilirubin into bound bilirubin, which is easily excreted from the body.

For non-conjugative hyperbilirubinemia, the administration of drugs that enhance the activity of liver enzymes, for example, phenobarbital, is effective.

In all cases, it should be remembered that jaundice, as a rule, is an indicator of serious disorders in the body, and therefore timely identification of its causes increases the likelihood of a favorable outcome and, possibly, a complete cure from the disease that caused it. You should not neglect visiting a doctor even in the case of slight yellow discoloration of the skin and sclera, because timely diagnosis and timely treatment can not only save the patient’s life, but also significantly improve its quality.